- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.04 / $206.00 / $343.21
| Professional | | $127.04 | $206.00 | $343.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.15 / $191.15 / $305.35
| Professional | | $191.15 | $191.15 | $305.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.25 / $261.22 / $403.49
| Professional | | $151.25 | $261.22 | $403.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.30 / $336.84 / $1,727.36
| Professional | | $238.30 | $336.84 | $1,727.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.30 / $270.64 / $437.53
| Professional | | $229.30 | $270.64 | $437.53 |